Clinical Usefulness of Prostate-specific Membrane Antigen-ligand Positron Emission Tomography/Computed Tomography for the Detection of Prostate Cancer Biochemical Recurrence after Primary Radiation Therapy in Patients with Prostate-specific Antigen Below the Phoenix Threshold: Systematic Review and Meta-analysis.

Autor: Subiela JD; Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain. Electronic address: jdsubiela@gmail.com., Gomis Sellés E; Radiation Oncology Department, University Hospital Virgen del Rocío, Biomedical Institute of Seville (IBIS)/CSIC/University of Seville, Seville, Spain., Maldonado A; Nuclear Medicine and Molecular Imaging Department, University Hospital Quiron-salud Madrid/La Luz Hospital, Madrid, Spain., Lopez Campos F; Radiation Oncology Department, University Hospital Ramon y Cajal, Madrid, Spain., Aumatell Ovide J; Department of Urology, Hospital Universitario Rey Juan Carlos, Madrid, Spain., Ajuria Illarramendi O; Nuclear Medicine Department, University Hospital Ramon y Cajal, Madrid, Spain., González-Padilla DA; Department of Urology, Clínica Universidad de Navarra, Madrid, Spain., Gajate P; Medical Oncology Department, Ramon y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain., Ortega Polledo LE; Department of Urology, Hospital Universitario Príncipe de Asturias, Universidad de Alcalá, Alcalá de Henares, Spain., Alonso Y Gregorio S; Institute of Urology, San Francisco de Asís Hospital, Madrid, Spain., Guerrero-Ramos F; Department of Urology, Hospital Universitario 12 de Octubre, Madrid, Spain., Gómez Dos Santos V; Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain., Rodríguez-Patrón R; Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain., Calais J; Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA, USA., Kishan AU; Department of Radiation Oncology and Department of Urology, University of California, Los Angeles, CA, USA., Burgos Revilla FJ; Department of Urology, Hospital Universitario Ramón y Cajal, IRYCIS, Universidad de Alcalá, Madrid, Spain., Couñago F; Department of Radiation Oncology, San Francisco de Asís Hospital, Madrid, Spain; Department of Radiation Oncology, La Milagrosa Hospital, Madrid, Spain; National Chair of Research, GenesisCare, Madrid, Spain.
Jazyk: angličtina
Zdroj: Clinical oncology (Royal College of Radiologists (Great Britain)) [Clin Oncol (R Coll Radiol)] 2023 Dec; Vol. 35 (12), pp. e676-e688. Date of Electronic Publication: 2023 Sep 27.
DOI: 10.1016/j.clon.2023.09.012
Abstrakt: Aims: After primary radiotherapy, biochemical recurrence is defined according to the Phoenix criteria as a prostate-specific antigen (PSA) value >2 ng/ml relative to the nadir. Several studies have shown that prostate-specific membrane antigen (PSMA)-ligand positron emission tomography/computed tomography (PET/CT) can help in detecting recurrence in patients with low PSA values. This study aimed to assess the detection rate and patterns of PSMA-ligand PET/CT uptake in patients with suspected biochemical recurrence after primary radiotherapy and with PSA levels below the Phoenix threshold.
Materials and Methods: The meta-analysis was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Articles providing data on patients with suspected prostate cancer recurrence after primary radiotherapy with a PSA value below the Phoenix threshold and who underwent PSMA-ligand PET/CT were included. Quality assessment was carried out using the Quality Assessment of Diagnostic Accuracy Studies-2 tool (QUADAS-2).
Results: In total, five studies were included, recruiting 909 patients (202 with PSA ≤2 ng/ml). The PSMA-ligand detection rate in the patients with ≤2 ng/ml ranged from 66 to 83%. The most frequent source of PSMA-ligand PET/CT uptake was local recurrence, followed by lymph node metastasis and bone metastasis. PSMA-ligand PET/CT uptake due to local-only recurrence was more likely in patients with PSA ≤2 ng/ml compared with PSA > 2 ng/ml: risk ratio 0.72 (95% confidence interval 0.58-0.89), P = 0.003. No significant differences were observed in the detection of PSMA-ligand uptake in other areas. Limitations include a lack of biopsy confirmation, cohort reports with small sample sizes and a potentially high risk of bias.
Conclusion: A significant detection of PSMA-ligand-avid disease was observed in patients with PSA levels below the Phoenix threshold. There was a higher likelihood of detecting local-only uptake when the PSA value was ≤2 ng/ml. The findings suggest that a critical review of the Phoenix criteria may be warranted in the era of PSMA-ligand PET/CT and highlight the need for further prospective trials.
(Copyright © 2023. Published by Elsevier Ltd.)
Databáze: MEDLINE
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